Anesthesia and analgesia
-
Anesthesia and analgesia · Aug 2016
Observational StudyImpact of On-Bypass Red Blood Cell Transfusion on Severe Postoperative Morbidity or Mortality in Children.
Children undergoing cardiac surgery are frequently exposed to red blood cell (RBC) transfusions mainly in the case of hemorrhage or low oxygen transport. However, in this population, RBCs are sometimes added to the cardiopulmonary bypass (CPB) priming solution to maintain a predefined hematocrit on bypass. In this study, we investigated the impact of RBCs added to the CPB on severe postoperative morbidity or mortality. ⋯ In the condition of our study, adding RBCs to the CPB priming to maintain a predefined hematocrit does not seem to impact markedly severe postoperative morbidity or mortality in children undergoing cardiac surgery. Only the risk of infection was increased in the CPB transfusion group. Further studies are warranted to better understand the complex interaction among severity of illness, anemia, RBCs transfusion, and outcome in children undergoing cardiac surgery.
-
Anesthesia and analgesia · Aug 2016
Observational StudyThe Association Between Progesterone, Estradiol, and Oxytocin and Heat Pain Measures in Pregnancy: An Observational Cohort Study.
Hormonal action has been implicated as a possible mechanism for pregnancy-induced analgesia. Previous investigators have reported an increase in heat pain tolerance during labor compared with nonpregnant controls and postulated it was because of the hormonal changes during pregnancy. However, these previous reports did not include measurement of hormonal values. The purpose of our study was to quantitatively test if changes in pregnancy hormone concentrations correlated with changes in temperature ratings. ⋯ Our findings show that amounts of estradiol and progesterone changed significantly between the term and the postpartum visit; however, the thermal pain tolerance did not significantly change. In summary, we did not observe an association between hormonal changes and changes in pain threshold measures. This finding argues against the concept of simple progesterone- or estrogen-induced analgesia in humans.
-
Anesthesia and analgesia · Aug 2016
Anesthetic Management of 65 Cases of Ex Utero Intrapartum Therapy: A 13-Year Single-Center Experience.
The anesthetic management for open fetal surgery has been described, but many therapeutic tenets have not been supported with data. We present data on the anesthetic management and outcomes of 65 patients undergoing ex utero intrapartum therapy procedures at the Children's Hospital of Philadelphia between 1998 and 2011. ⋯ High levels of volatile anesthetic were used for uterine relaxation. Case characteristics such as fetal procedure, operative time, blood loss, transfusion requirements, vasopressor use, and fetal resuscitative measures are described.
-
Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. ⋯ Among inpatients ≥45 years of age who are having noncardiac surgery, the number necessary to screen to detect myocardial injury after noncardiac surgery, that would otherwise be missed, is only about 15 patients. Thus, troponin screening seems appropriate for most surgical inpatients who are ≥45 years of age. Potential acute interventions include initiating therapy such as aspirin, statins, and angiotensin-converting enzyme (ACE) inhibitor antihypertensives, along with chronic lifestyle improvements such as smoking cessation, healthful eating, and exercise.
-
Anesthesia and analgesia · Aug 2016
Heterogeneity in the Structure of the Left Ventricular Outflow Tract: A 3-Dimensional Transesophageal Echocardiographic Study.
The left ventricular outflow tract (LVOT) is a composite of adjoining structures; therefore, a circular or elliptical shape at one point may not represent its entire structure. The purpose of this study was to evaluate the presence of heterogeneity in the LVOT. ⋯ There was heterogeneity in the major axis diameter and cross-sectional area for the different regions of the LVOT. The distal LVOT (aortic side) was more circular, whereas the proximal LVOT (left ventricular side) was more elliptical in shape. This change in shape from circular to elliptical was accounted for by a difference in the major axis diameter from proximal to distal LVOT and a relatively similar minor axis diameter. Although the clinical significance of this finding is unknown, the assumption of a uniform structure of LVOT is incorrect. Three-dimensional imaging may be useful for assessing the LVOT shape and size at a specific region of interest.